At present, changes in the educational process of doctor’s training are actively taking place — to the personality-oriented, knowledge-action orientation. In this regard, the main activity of medical universities is actively directed not to the simple formation of students’ knowledge, skills and abilities, but to a set of basic competencies in intellectual, communication, information and other spheres [1]. The term «competence» is broader than the concept of knowledge or skills. It is characterized by the following features: multifunctionality (mastering of which will allow solving problems of everyday, professional and social life), intellectual development (development of own position, self-assessment, critical thinking), multidimensionality (mental processes, intellectual skills), interdisciplinarity.

One of the main conditions in the formation of competencies is the active involvement of students in the learning process, which naturally implies updating the content of education, its methods and technologies [4]. This is relevant for all academic disciplines of medical universities [2], including ours – «pathophysiology, clinical pathophysiology». The purpose of its mastering is to form the students’ ability to effectively solve professional tasks on the basis of pathophysiological analysis of data on diseases, clinical syndromes using knowledge about the general regularities of development.

To realize this goal, we offer a number of competencies (according to the Federal State Standard of Higher Education), the successful mastering of which is very difficult without the use of innovative teaching methods. In the educational process we actively introduce constructive pedagogy — a direction that provides intensification of learning with the use of active methods and means, as well as pedagogical creativity in communication with students.

For several years, we have been conducting a series of role-playing games on various educational topics on the basis of one of its subsections (elements) in practical classes. Role-playing is one of the forms of active learning methods — a full-fledged part of the educational process [3]. Its scenario is carefully thought out and prepared by teachers.

As an example, a brief role-play scenario of the educational topic «Pathophysiology of tumor growth» is offered.

Objective of the game: to identify and characterize the etiological factors of tumor growth; to consolidate ideas about the mechanisms of tumor process development; to discuss the anti-blast defense mechanisms of the organism.

Concept: Role play examines the role of etiological factors in the development of tumor growth and the importance of antitumor defense mechanisms.

At the beginning of the game, the teacher should divide the study group of students into subgroups:

— Presenter.

— Tumor and its derivatives: tumor, metastasis, oncoproteins.

— Pathogenicity factors: — physical carcinogenesis, biological carcinogenesis, chemical carcinogenesis

— Defense factors: — immune and non-immune defense factors

Expected results: to model the situation on the given pathophysiological process. To identify theoretical errors of students at each stage of the business game, to correct these errors.

Situation development: the number of participants in the business game depends on the number of students in the study group and the complexity of the situation. The participants in this case are: presenter, tumor, metastases, oncoproteins, immune system of the body, non-immune defense factors, physical carcinogenesis, chemical carcinogenesis, biological carcinogenesis.[2]

Introductory information on the situation being played out:

Tumor (neoplasm, blastoma, neoplasm) is a pathological growth that differs from other pathological growths (hyperplasia, hypertrophy, regeneration after damage) by hereditary ability to unlimited, uncontrolled growth. There are two main types of tumors — benign and malignant.

Benign tumors. These tumors grow by pushing adjacent tissue, sometimes compressing it, but usually not damaging it; in some cases, they are encapsulated. Benign tumors, as a rule, do not have an adverse effect on the body, so they can be considered as a local increase in tissue, not interfering with the administration of vital functions. Their clinical significance is small. The only exception is when the very localization of the tumor is a factor that threatens the vital functions of the body, for example, when it occurs in the brain and the resulting compression of nerve centers.

Malignant tumors. This is a large group of severe, chronic diseases, ending, as a rule, with a fatal outcome, if there was no or delayed treatment. Malignant tumors are characterized by invasive growth, they infiltrate adjacent tissues, form perifocal foci of inflammation, often metastasize to nearby lymph nodes and distant tissues, have a generalized effect on the entire body, disrupting its homeostasis. All the following description is devoted to the description of this type of tumors.

Biological features of malignant tumors:

— decrease in the level of differentiation of tumor cells — atypism, anaplasia. There are differentiated: biochemical anaplasia, tissue and cellular anaplasia, physicochemical anaplasia, functional anaplasia, immunological anaplasia.

— heritability of changes.

— invasive and destructive growth.

— metastasis.

— progression.

Tasks for actors:

Questions about the tumor: characteristics, classification of tumors — Main biological features of the tumor — Leading mechanisms of blast transformation —

Questions about metastasis: what causes metastases- What determines the rate of spread of metastasis in the body- What are the dangers of metastasis-

Questions for oncoproteins: What are the mechanisms by which pro-oncogenes become active cellular oncogenes?

Questions about the body’s immune system: What is the body’s defense mechanism against tumor growth- Why does HIV infection impair protection against neoplastic processes- Explain the mechanism of action of anticarcinogenic factors.

Questions on physical carcinogenesis: The main representatives of physical carcinogenic factor-

Questions on biological carcinogenesis: Name the main representatives of DNA- and RNA-containing oncoviruses-

Questions for chemical carcinogenesis: name the pathways of entry of chemical carcinogens into the human body- Explain the effect of chemical carcinogens on tumor growth.

A sample plan for conducting a business game on the topic «tumors».

Presenter: The problem of tumor growth is one of the central issues in modern medicine. Its importance is explained by the fact that every year more than 5 million people in the world suffer from tumors, and two million of them die every year. Mortality from malignant tumors ranks second in the world, second only to mortality from cardiovascular diseases.

In recent decades, there has been a significant increase in the incidence of tumors. To a certain extent, this increase is relative, as oncologic diagnostics is improving every year. In addition, the average life expectancy of people has increased, and tumors are most often a disease of the elderly.

But in addition to this relative growth, there is also an absolute increase in the number of malignant tumor diseases, especially in urban areas, which is primarily due to adverse environmental factors.

Chemical carcinogenic factor: My effect on the organism is very great. I can be present both in the external environment and formed inside the body (list representatives and explain their effect on the body). Can enter the human body at:

— chemical production

— metallurgical plant, when using nitrates, pesticides in agriculture

— by exposure to exhaust fumes.

I can also penetrate through the placenta from mother to fetus, and my exposure can cause premature labor, fetal deformities.

Biological carcinogenesis: I am an oncovirus, that is, a tumor-causing virus. I can be either RNA-containing (Oncornaviridae: leukosarcomatosis complex of monkeys, mice, rats, or DNA-containing (Papovaviridae group, smallpox virus group, adenoviruses, herpes virus group). I can give some examples: Berkitt’s lymphoma is caused by exposure to Epstein-Barr DNA virus, and cervical cancer is caused by papillomavirus types 16, 18, 52.

Physical carcinogenic factor: my main representatives are solar, ultraviolet and ionizing radiation. It has already been proven that the main etiological factor of skin cancer is ultraviolet and solar radiation, and X-ray skin cancer and leukemia in radiologists can be caused by exposure to ionizing radiation.[5]

Tumor: I malignant tumor, that is, an abnormal overgrowth of cells characterized by their uncontrolled division. I can be formed due to carcinogenic factors. In the process of my development, 5 stages are distinguished: transformation of proto-oncogenes into active cellular oncogenes; expression of active cellular oncogenes; transformation of a normal cell into a tumor cell; multiplication of a tumor cell and formation of a primary tumor node; further growth and progression of the tumor. Characterize each stage.

Presenter: despite the huge number of active factors that contribute to the growth and development of tumor cells, the body can include a number of protective mechanisms.

Immune system: I immunologic supervision of the constancy of the normal antigenic composition of tissues and organs. My mechanisms are divided into innate and adaptive immune mechanisms. Characterize each mechanism in detail. When exposed to a number of factors, including HIV infection, my defenses may be impaired (give examples, explain the mechanism).

Non-immune defense factors — I include: allogeneic inhibition; keylon inhibition; lipoprotein-induced carcinolysis; contact inhibition; labrocytosis; and the regulatory influence of hormones. Characterize each mechanism.

Presenter: However, despite such powerful protection of the body, the tumor cell can «cheat» the immune system. During tumor growth, suppressive substances are synthesized (activating T-regulatory cells (natural suppressors) at the very beginning of tumor growth). Tumor cells synthesize chorionic gonadotropin (which has a suppressive effect). As a result, the immune system is suppressed at the very beginning of tumor growth.

Metastases and oncoproteins play an important role in tumor development.

Metastasis: I tumor cell moved from the primary parent tumor, to distant organs and tissues and form new, secondary tumor nodes of the same histological structure in them. I move lymphogenously, hematogenously, hemato-lymphogenously, implantation and cavity (characterize each pathway and name the stages of metastasis).

Oncoprotein: I am an oncoprotein, synthesized in various amounts and programmed by active cellular oncogenes. With my help, the tumor genetic program is transformed into actual tumor features and their atypisms. In normal cells I function for a long time as a regulator of sensitivity of their receptors to growth factors.

After conducting the business game, it is necessary to discuss the results and correct the theoretical errors of students, to evaluate the activity of the game participants and encourage the best participants.

Our experience of conducting role-playing games has demonstrated an undoubted advantage over traditional forms of training. The game promotes active learning of complex experimental and clinical material by students, positively affects intellectual activity, formation of cognitive activity and, consequently, the formation of competence not only professional, but also general cultural.

According to the students (questionnaire data), this form of classes significantly reduces their «tense-anxious» state, present during the traditional survey. Communication with professors becomes freer and more democratic, which allows deeper and more detailed consideration of various nuances of this or that pathological process, disease, while receiving intellectual pleasure. More than 70% of the surveyed students note the increase in their motivation to study and the correctness of the choice of the profession of a doctor.

There are also a number of disadvantages of this form of training — some students treat the game as a «show», a free pastime; others are insufficiently prepared for the game, relying on their extraordinary abilities (impromptu, aggressiveness in the dialog).

Elimination of the identified negatives is based on a more thorough elaboration of the scenario of games, their didactic and educational purpose, emotional and motivational background. No less important is the strengthening of the individual approach to the trainee, aimed at the initiation of cognitive need and self-development.